1134189178 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO

Table of content: (NPI 1134189178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134189178 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134189178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 ALBERTA AVE.
Provider Second Line Business Mailing Address:
230C
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-545-6664
Provider Business Mailing Address Fax Number:
915-545-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 ALBERTA AVE.
Provider Second Line Business Practice Location Address:
230C
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-545-6664
Provider Business Practice Location Address Fax Number:
915-545-9799
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUCIARELLI
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FOR FINANCE AND ADMI
Authorized Official Telephone Number:
915-215-4300

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CC8142 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084600801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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